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Erschienen in: International Orthopaedics 4/2015

01.04.2015 | Original Paper

A nationwide analysis of risk factors for in-hospital myocardial infarction after total joint arthroplasty

verfasst von: Mariano E. Menendez, Stavros G. Memtsoudis, Marion Opperer, Friedrich Boettner, Alejandro Gonzalez Della Valle

Erschienen in: International Orthopaedics | Ausgabe 4/2015

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Abstract

Purpose

Despite acute myocardial infarction (AMI) being a feared medical complication and currently a major cause of death after total hip and knee arthroplasty (THA/TKA), little is known about its peri-operative associated factors.

Methods

Data for this retrospective cohort study were extracted from the Nationwide Inpatient Sample for 2008–2011. Multivariate logistic regression modeling was performed to determine peri-operative factors associated with the development of inpatient AMI following THA/TKA.

Results

An estimated 3,096,791 procedures were identified. Perioperative AMI rates were 0.25 % for THA and 0.18 % for TKA. Patients with AMI had significantly greater comorbidity burden, higher peri-operative mortality rates, longer length of hospital stay and increased complication rates. Independent risk factors for the development of AMI comprised advance age, male gender [odds ratio (OR) 1.4, 95 % confidence interval (CI) 1.4–1.5], THA surgery (OR 1.3, 95 % CI 1.3–1.4), low household income (OR 1.3, 95 % CI 1.2–1.4), history of cardiac disease (coronary artery disease: OR 4.9, 95 % CI 4.6–5.2; congestive heart failure: OR 2.6, 95 % CI 2.4–2.8; valvular disease: OR 1.2, 95 % CI 1.1–1.3), diabetes (OR 1.1, 95 % CI 1.1–1.2), pulmonary circulation disorders (OR 1.4, 95 % CI 1.2–1.6), cerebrovascular disease (OR 2.3, 95 % CI 2.0–2.6), peripheral vascular disorders (OR 1.5, 95 % CI 1.4–1.7), coagulopathy (OR 1.4, 95 % CI 1.2–1.5), AIDS/HIV infection (OR 7.9, 95 % CI 4.5–13.9), deficiency anaemia (OR 1.4, 95 % CI 1.3–1.5), fluid and electrolyte disorders (OR 1.9, 95 % CI 1.8–2.0) and the occurrence of concomitant postoperative complications.

Conclusion

Our findings can be used to better identify patients at high risk of AMI and to develop strategies aimed at diminishing its incidence, which could in turn translate to improved hospital efficiency and quality of care.
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Metadaten
Titel
A nationwide analysis of risk factors for in-hospital myocardial infarction after total joint arthroplasty
verfasst von
Mariano E. Menendez
Stavros G. Memtsoudis
Marion Opperer
Friedrich Boettner
Alejandro Gonzalez Della Valle
Publikationsdatum
01.04.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 4/2015
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-014-2502-z

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